Exclusive: The rule was applied regardless of whether the medical emergency
could have been helped by a defibrillator, or whether any attempt was made
to use it, a leaked report reveals

The NHS chief at the centre of a growing 111 scandal authorised a separate policy which meant 999 calls were recorded as receiving a swift response - even if no help was given, a leaked report reveals.

The head of South East Coast Ambulance trust ordered the secret scheme, which improved its apparent performance against national targets.

Under NHS rules, 75 per cent of calls assessed as “life-threatening” should receive a response within eight minutes.

The rogue protocols were agreed by trust executives in March 2014, and then “backdated” to improve performance of calls since January of that year, the report says.

They remained in place until the practice was exposed by this newspaper last November.

The protocol was directly authorised by the trust’s chief executive, the report says.

“Email from CE taken as substitute for governance,” the summary states.

The latest disclosure comes as Mr Sutton is under pressure to resign for authorising a separate secret policy, in contravention of NHS rules.

The policy meant a deliberate delay for thousands of responses to life-threatening calls which came to the ambulance service via 111.

The Daily Telegraph revealed the findings of a draft “forensic review” of the matter, which said Mr Sutton pushed the policy through despite direct pleas to him from senior managers raising concerns about the dangers of the scheme.

The ambulance trust invented its own system to “stop the clock’” on thousands of calls, routinely downgrading the response to patients who came via 111.

As a result, up to 20,000 callers, including cases classed as “life-threatening” were told that an ambulance was on its way, when in fact it the call had been placed in a queue, adding up to 10 minutes to the response time.

The report is damning about the part played by Mr Sutton, in introducing the policy, which was only stopped when a whistleblower contacted local NHS commissioners warning of a number of deaths among patients who were subjected to the delays.

A separate review is examining the impact of the protocols, which were in place for two months, on patients.

Last night patient safety campaigners said Mr Sutton’s position had become untenable, and said the rest of the board should consider their positions.

Peter Walsh from the patient safety charity Action against Medical Accidents said: "The findings of these investigations are truly shocking and it is vital for public confidence that we see accountability and system learning to prevent this kind of thing happening again.

"It seems obvious that the chief executive should go but this isn't just about one (albeit very senior) manager. The role of the board as a whole needs to be dealt with. It is clear there was wider knowledge of what was going on and any decent system of governance should have been capable of stopping this dangerous and unethical approach.”

"This confirms our previous serious concerns about secretive decision-making and cover-up at SECamb," she said. "The public expects that those in leadership positions are held accountable for their actions. "

A spokesperson for the trust said: "The independent Review was commissioned by the Trust to provide clarity and further assurance on our processes. It continues the Trust’s position of regularly seeking independent audit and assurance on performance reporting."

She said the trust still maintained it had been compliant with national guidance although not with additional guidelines published in 2014.

The trust complies with latest guidance, she said.

A Department of Health spokesman said: "These are very serious allegations. Ambulance services must adhere to national standards - so we are carefully monitoring the situation and await results of the trust's review.